Mesh dispenser

ABSTRACT

A dispensing device configured to operate with an adhesive backed mesh and backing film for tissue bonding is disclosed. The dispensing device provides for low-friction, low force pay-out of a desired length of an adhesive backed mesh to a wound site. The device prevents or eliminates distortion of the mesh prior to application to the wound site, and includes means for reducing or eliminating binding during use. The dispensing device is configured to operate in a “forward” mode (substrate to which mesh is applied passes beneath applicator after mesh is applied) to provide essentially an unobstructed view of the wound site during use.

FIELD

The present invention relates to a dispenser device forapplying/dispensing a mesh.

BACKGROUND

Presently, patients undergoing surgical procedures requiring longincisions may require their incisions to be closed using sutures,staples, and/or adhesive strips. All of these closing methodologies mayhave difficulties, to varying degrees, with patient comfort, speed (forthe clinician), clinical outcome (suture related infection/irritation),recovery time and cosmesis.

Skin closure strips, such as conventional adhesive bandages, areutilized for closure of relatively superficial skin wounds. However, thecontact adhesives that are used with such strips typically retainadhesion for no more than a day or two and can lose adhesion quickly inthe presence of moisture, for example, perspiration.

While improved materials and methods for wound approximation aregenerally known, for example, co-assigned U.S. Patent ApplicationPublication No. 2006/0009099, these improved materials may be moregenerally accepted and more widely used if dispensing devices adapted tothe unique characteristics of these materials were available. Therefore,a need continues to exist for devices and methods for dispensingmaterials useful in wound approximation and tissue bonding to provide awider range of applications for these materials, from external tointernal use, and from essentially non-biodegradable (where thematerials are removed from the application site) to biodegradable (wherethe materials are not directly removed from the application site anddegrade over time).

SUMMARY

Devices and methods for dispensing materials useful in woundapproximation and tissue bonding are provided. The device is adapted tocharacteristics of the materials used in wound approximation and tissuebonding. Methods of tissue bonding using the device are also provided.

In an embodiment, a mesh dispensing device is provided. The devicecomprises a housing having an opening. A supply spool is rotatablymounted in the housing, the supply spool comprising a spool of mesh andbacking film, the mesh comprising an adhesive substance applied over atleast a portion of a side of the mesh, and the backing film detachablyadhered to the adhesive substance. At least one guide element is mountedin the housing receiving the mesh and the backing film from the supplyspool, such that the adhesive side of the mesh is presented at theopening of the housing. A take-up spool is rotatably mounted in thehousing, the take-up spool rotatably coupled with the supply spool forreceiving the backing film. Means for reducing or eliminating binding orslack of the detached backing film as the mesh is dispensed areprovided.

In another embodiment, a method for dispensing a mesh for tissue bondingis provided. The method comprises providing a spool of mesh comprising apressure sensitive adhesive applied over at least a portion of a side ofthe mesh, a polymerization initiator disposed in or on the mesh, and abacking film detachably adhered to the pressure sensitive adhesive. Adispensing device is provided, the dispensing device comprising ahousing having an opening, the housing further comprising a pair ofparallel projections at the opening. A supply spool is rotatably mountedin the housing receiving the spool of mesh and the backing film. A setof guide elements, where at least one guide element of the set of guideelements is rotatably mounted on the pair of projections andcooperatively receives the mesh and backing film from the supply spooland presents the pressure sensitive adhesive side of the mesh at theopening of the housing. A take-up spool is rotatably mounted in thehousing, the take-up spool rotatably coupled with the supply spool forreceiving the backing film from the set of guide elements. Means forreducing or eliminating binding or slack of the detached backing filmare provided. A tissue surface is contacted with at least a portion ofthe pressure sensitive adhesive side of mesh presented by at least oneof the set of guide elements. A portion of the pressure sensitiveadhesive side of the mesh is adhered to the tissue surface. Thedispensing device is operated in a forward direction by pushing orpulling the device along the tissue surface such that the adhered meshdrives the take-up spool with separation of the backing film at the setof guide elements. The mesh from the dispensing device is dispensed.

In another embodiment, a method for tissue bonding is provided. Themethod comprises providing a tissue surface in need of bonding. Adispensing device is provided comprising a housing having an opening,the housing further comprising a pair of parallel projections at theopening. A supply spool is rotatably mounted in the housing, the supplyspool comprising a spool of mesh and backing film, the mesh comprising apressure sensitive adhesive applied over at least a portion of a side ofthe mesh, and a backing film detachably adhered to the pressuresensitive adhesive. A set of guide elements, where at least one guideelement of the set of guide elements is rotatably mounted on the pair ofprojections cooperatively receives the mesh and the backing film fromthe supply spool and presents the pressure sensitive adhesive side ofthe mesh at the opening of the housing. A take-up spool is rotatablymounted in the housing, the take-up spool rotatably coupled with thesupply spool for receiving the backing film from the set of guideelements. Means for reducing or eliminating binding or slack of thedetached backing film are provided. The tissue surface is contacted,where at least a portion of the pressure sensitive adhesive side of themesh is positioned between the tissue surface and at least one of theset of guide elements. At least a portion of the pressure sensitiveadhesive side of the mesh is adhered with the tissue surface. The meshis dispensed from the opening of the dispensing device by operating thedispensing device in a forward direction along the tissue surface.

In another embodiment, a kit comprising the mesh dispensing device asdescribed above and a polymerizable adhesive composition is provided.

The dispensing device herein disclosed may be used to dispense amaterial suitable for bonding a variety of tissue ranging from hardtissue (such as bone) to soft tissue (such as skin, organs, mucousmembranes, and the like). The tissue can be either internal or external.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A and 1B are a perspective views of dispenser embodiments hereindisclosed.

FIG. 2 is an exploded view showing various elements of a dispenserembodiment of FIG. 1.

FIG. 3 is a plan view showing the assemblage of elements of theembodiment of FIG. 1.

FIG. 4 is an exploded view of the embodiment of FIG. 1A.

DETAILED DESCRIPTION

Devices and methods for dispensing materials useful in woundapproximation and tissue bonding are provided. The device is adapted tocharacteristics of the materials used in wound approximation and tissuebonding, in particular, components of composite products used in tissuebonding.

Composite products comprised of a tissue bonding material, such as anadhesive backed mesh, for example, used in conjunction with apolymerizable adhesive composition may be used for tissue bonding. Useof the aforementioned material requires that the mesh be adhered to asubstrate, for example a patient's skin or tissue, straddlingwell-approximated wound edges. The polymerizable adhesive composition,for example, a cyanoacrylate (CA) adhesive may then be applied over themesh after it is applied to a patient, further securing the mesh inplace and promoting wound closure. The adhesive backed mesh holds thewound edges in place prior to application of the CA adhesive, and mayprovide a matrix for supporting initiating chemicals that modulate thecuring rate of the CA adhesive and may also provide mechanicalreinforcement of the CA adhesive.

To work effectively, the adhesive backed mesh preferably should be inintimate contact with the patient's skin over its entire surface.“Tenting” of the mesh (e.g., air gaps between the patient's skin and themesh) may result in gaps that do not fill-in when the CA adhesive isapplied, resulting in a discontinuous closure and/or area of weakadhesion, which may lead to premature separation of the incision.Furthermore, the surface to which the mesh is being applied may beundulating in its topography (e.g., being curved in 3-dimensions). Toaddress these requirements, the adhesive backed mesh is typicallyflexible and compliant.

The adhesive backed mesh, which may be provided in the form of a strip,preferably should be precisely applied to the patient's skin such thatthe wound line is centered along the axis of the mesh strip as to evenlydistribute the load on either side of the wound after completingapplication of the mesh strip (for approximating opposite sides of thewound line, for example). Lastly, the adhesive backed mesh preferablyshould hold the wound edges in alignment prior to application of the CAadhesive to ensure a desirable cosmetic outcome.

Collectively, the aforementioned attributes of an adhesive backed meshprovided in simple strip form may make it impractical to provideadequate tissue bonding in certain situations. There may be too manycontrol points for the clinician to manage in order to provide anoptimal deployment of the mesh, for example, where wounds are quite long(e.g., circumscribing a patient's entire body).

In addressing the aforementioned, a dispensing device configured tooperate with an adhesive backed mesh and backing film for tissue bondingis provided. The dispensing device provides for low-friction pay-out ofa desired length of the adhesive backed mesh. The device minimizes,prevents, or eliminates distortion of the mesh prior to application tothe wound site, and reduces or eliminates binding during use.

Moreover, the dispensing device herein disclosed is configured tooperate with one hand in a “forward” mode or direction to provideessentially an unobstructed view of the wound site during use. By meansof the “forward” mode or direction, the adhesive side of the mesh isdispensed and presented via passing beneath the device. For example, themesh is applied to a longitudinal wound starting at a region proximal tothe dispenser and moving the dispenser along the longitudinal dimensionof the wound towards a distal region. The mesh is dispensed by passingunder the dispenser leaving an applied mesh on the wound site startingat the proximal region and extending towards the distal region such thatthe view of the distal portion of the wound is substantiallyunobstructed by the dispenser as it is moved along the longitudinaldimension of the wound. Such mode of operation may provide for improvedsurgical and clinical application of the aforementioned composite tissuebonding products.

The dispenser herein disclosed provides for the surface of the adhesivebacked mesh, which ultimately adheres to the substrate to which it isbeing applied, being oriented toward a backing film. Moreover, thedispenser herein disclosed reduces or eliminates the tensile loadrequired to pay the tape from the dispenser, which may otherwise resultin the mesh distorting and/or elongating and may lead to undesirabletenting of the mesh, for example. For similar reasons, the dispenseravoids highly frictional operated clutching mechanisms used to controlbinding and slack used in conventional dispensing devices that otherwisemay distort or elongate the adhesive backed mesh. Additionally, thedispensing device herein disclosed is operable in a “forward” modeallowing visualization of the substrate immediately ahead of where themesh is to be applied. Such a mode of operation may be ideal for asurgical setting where the clinician may need to follow anirregularly-shaped wound that may traverse over undulating contour. Suchadvantages are not collectively addressed in dispensers designed forconventional adhesive tape and other materials not directed to use intissue bonding.

The device herein disclosed is adapted for use with materials that canbe applied to a surface, and impregnated with a polymerizable adhesivecomposition, which upon setting or curing provides an adherent structureover the surface. For example, any adhesive backed mesh (or adhesivebacked flexible material) suitable for use in the dispenser disclosedherein includes materials suitable for tissue bonding. Suitable flexiblematerials include, for example, those described in co-assigned U.S.Patent Application Publication No. 2006/0009099, incorporated herein byreference in its entirety. The mesh is preferably flexible or compliant,to allow the mesh to be placed on the desired surface (such as skin,organ, tissue, or the like) in a manner that allows the mesh to conformto the topology of the desired surface. Likewise, the mesh is preferablyporous, to allow a subsequently applied polymerizable adhesivecomposition to pass through or permeate through the mesh and topolymerize, while adhering the mesh to the desired surface. A flexiblematerial such as a film or tape may also be dispensed in the dispenserdescribed herein instead of a mesh.

Preferably, the mesh comprises an adhesive substance on all or part ofone side of the mesh. The strength of the adhesive substance on a lowersurface of the mesh is such as to hold the mesh in position on thepatient until the polymerizable adhesive composition may be applied.

A device for dispensing a mesh for purposes of tissue bonding isprovided. Using the device as herein disclosed, application of the meshis achieved without distortion of the mesh, allowing conforming toundulating/curved topography. Using the device as herein disclosed,application of the mesh may be achieved without compromise of theclinician's visualization of the wound edge during application.

The device herein disclosed allows for a one-handed mesh placementoperation adaptable to long pieces of an adhesive backed mesh. Thedevice may allow use of gloved hands and for the user to more accuratelyapproximate a wound edge, for example, over an undulating path withminimal distortion to the mesh while providing clear visualization ofthe target trajectory.

The mesh dispenser as herein disclosed generally comprises a housing.The housing comprises a rear end, a front end, and an opening at thefront end, a spool of mesh and backing film, a supply spool and take-upspool, the supply spool and take-up spool rotatably coupled, at leastone guide element, and means for reducing or eliminating binding orslack of the backing film.

The housing of the dispenser herein disclosed may be constructed ofplastic, metal, or combinations thereof. The housing may includesegments that are secured together. The segments of the housing may besecured during assembly by fastening means. The segments may bereversibly secured by securing the segments together such as by a hingeor latch for replacing and/or assembling the components of thedispenser. The segments may contain receiving elements cooperativelypositioned for the accepting and/or mounting of components, such as forexample, axles for spools and/or guide elements.

The housing may include one or more forward projections at the openingthat provide for mounting one or more guide elements that facilitate thedispensing, contacting, and/or adhesion of the mesh to the wound site.The projections may include a pair of parallel positioned arms adaptedto mount one or more guide elements, such as for example, one or moreguide rollers.

The mesh dispenser as herein disclosed comprises a take-up spool and asupply spool rotatably mounted within the housing. The take-up andsupply spools may be constructed of plastic, metal, or combinationsthereof. The take-up and supply spools are sized such that they arereceived by corresponding take-up/supply mounting axles, the axles beingmounted on the inside of the housing so that the take-up and supplyspools may rotate thereon. The take-up spool may comprise a sleevehaving a slit or gap (e.g., a “c-sleeve”) about its outer diameter forreceiving the backing film between the sleeve and the take-up spool. Thetake-up spool and the supply spool may comprise an annular track forcooperatively accepting clutch means, such as an elastomeric belt.

The take-up and supply spools are rotatably coupled to each other toprovide opposite unidirectional rotation such that the take-up andsupply spools cooperatively function to release the mesh with attachedbacking film and to accept the detached backing film during use. Thetake-up and supply spools may be rotatably coupled, for example, withspur gears or frictionally engaged members. One or more pawls, incooperative relation with one or both of the spur gears, for example,may be used to prevent reverse rotation of the spools.

As material pays off the supply spool and accumulates on the take-upspool the diameter of the two spools will change, increasing the surfacevelocity of the take-up spool and decreasing the surface velocity of thesupply spool. This will cause a condition where the take-up spool willaccumulate material at an increasing rate, eventually removing any slackin the system, which may cause the take-up and supply spools to bind.For clinical applications requiring short lengths of mesh, the initialtake-up and supply spool diameters and gear ratios may be adjusted sothat the mesh and backing film supply is exhausted before slack isinitially created and before the spool diameters/gear ratios transition(from pay out and accumulation) such that the slack is consumed.However, for clinical applications requiring long lengths of mesh to beapplied to a wound site, this approach is not feasible because ofbinding.

In view of the aforementioned binding, the rotatably coupled take-up andsupply spools may independently include means for reducing oreliminating binding or slack in dispensing of long lengths of the meshin the normal operation of the mesh dispenser. The means provided avoidthe undesirable event of slack material or backing film accumulating inthe applicator or tightening and/or binding resulting from theeffectively changing diameters of the spools resulting from mesh andbacking film depletion from the supply spool and backing film build-upon the take-up spool.

Means for reducing or eliminating binding or slack in dispensing of themesh in the normal operation of the mesh dispenser independentlyinclude, for example, slip clutch elements or backing film tensioners.The clutch element may comprise a frictional member. In someembodiments, the clutch is used in combination with spool diametersand/or gear ratios such that the surface velocity of the take-up spoolis greater than the surface velocity of the supply spool. In such aconfiguration, build up of backing film slack and binding of the backingfilm is reduced or eliminated.

The clutch element may comprise a sleeve and a frictional memberproviding an interference fit between the sleeve and the take-up or thesupply spool. The friction member may be an o-ring, for example. Thesleeve comprises a sleeve inner diameter sized to be received by thetake-up spool or the supply spool. The frictional member may bepositioned between the sleeve and the supply spool or the take up spool.The frictional member may be positioned using a counter-bore at eitherend of the spool or sleeve. The dimensioning of outer diameters of thetake-up or supply spool, the inner diameter of the sleeve, and thethickness of the frictional member may be adjusted such that there is aninterference fit in an assembled state. This configuration provides aslip clutch coupling between the sleeve and spool. A frictional membermay include a surface element incorporated on the sleeve or the spool ora surface treatment of the sleeve or spool.

The amount of interference between the sleeve or the spool and thefrictional member may be adjusted to provide a target amount of forcesuch that slack is removed while not causing distortion of the meshand/or that binding is prevented or eliminated during use. Inembodiments, the amount of force required to cause the aforementionedclutch element to slip may be adjusted to be less than the force neededto distort the mesh. This may be between about 0 lb to about 1 lb, andmay preferably be between about 0.4 lb to about 0.6 lb.

A tensioner for reducing or eliminating binding or slack during normaluse of the mesh dispenser may be used. The tensioner may include acooperatively joined spring and lever assembly mounted within thehousing. The tensioner may be used independently or in combination withthe clutch elements. The spring and lever assembly is preferably coupledwith a guide roller accepting the backing film. The tensioner, forexample may comprise a spring secured to the housing at one end of thespring and a lever, the lever pivotally secured to the housing at oneend of the lever. A tensioning element may be secured to an opposite endof the spring and an opposite end of the lever, the tensioning elementpositioned such that the take-up spool is between the tensioning elementand the opening in the housing, the tensioning element receiving thebacking film prior to the take-up spool. The axial load of the springand lever tensioner may be selected to optimize the detachment of thebacking film from the mesh. The tensioner may be an assembly comprisinga spring and lever, each positioned within the housing and pivotablycoupled to a tensioning element. The tensioning element positioned suchthat the take-up spool is between the opening of the housing and thetensioning element. The backing film traverses around the tensioningelement prior to being received by the take-up spool so as to providetension control and/or remove slack from the routing of the backingfilm.

By way of example, slip clutch elements may include a take-up spoolrotatably mounted within the housing, the take-up spool having a take-upspool outer diameter; a sleeve having a sleeve inner diameter; and anelastomeric o-ring providing an interference fit between the sleeveinner diameter and the take-up spool outer diameter.

Further by way of example, slip clutch elements may include a supplyspool rotatably mounted within the housing, the supply spool having asupply spool outer diameter; and a sleeve having an an inner diameter;and an elastomeric o-ring providing an interference fit between thesleeve inner diameter and the supply spool outer diameter.

Further by way of example, a tensioner assembly may be used. Thetensioner assembly may comprise a spring and lever, each positionedwithin the housing and pivotably coupled to a tensioning element, thetensioning element positioned rearward of the take-up spool in thehousing such that the backing film traverses around the tensioningelement prior to being received by the take-up spool so as to providetension to the backing film.

Further by way of example, an elastic drive belt rotatably coupling thetake-up spool and supply spool, the elastic belt providing slippage ofthe take-up spool, may be provided.

The sleeve of either the take-up spool or the supply spool may containmeans for receiving clutch elements. For example, the sleeve may containan annular groove in its inner diameter for receiving clutch elements.The outer diameter of either sleeve may be adjusted to optimize theratio of take-up/supply spool diameters.

The mesh dispenser as herein disclosed comprises one or more guideelements mounted within the housing and/or mounted at the opening of thehousing. Guide elements provide, in part, that the mesh and backing filmor the detached backing film pass through the device in a controlledmanner and do not inadvertently become tangled or jammed from slack inthe mesh and backing film during assembly or use. The guide elements maybe constructed of plastic, metal, or combinations thereof. For example,the guide elements may be teflon, polyethylene, ultra-high molecularweight polyethylene or stainless steel. Preferably, the guide elementshave a low surface friction such that facile traversing of the detachedmesh, detached backing film, or mesh and backing film over the guideelement surface is provided. When passing over the guide elements, theadhesive side of the mesh is oriented away from the guide elements so asto prevent or eliminate adhesion of the mesh to the guide elements.Thus, it is preferable that the guide elements are constructed or coatedwith a material with poor adhesion to the adhesive substance such thatthe adhesive substance on the mesh does not adhere to the guide element,compromising subsequent operation of the device. In embodiments, theguide elements are made of polyethylene.

The guide elements may independently be rotatably mounted on axleswithin the housing, at the opening of the housing, or between theprojections from the housing. The rotatably attached guide elements maybe received by guide axles, the guide axles fixedly mounted within thehousing or at the opening, or fixedly mounted between the projections ofthe housing. The guide elements may independently be fixedly mounted inthe housing, at the opening, or between the projections from the housingprovided that the surface of the guide elements is of low friction. Lowsurface friction may include the application of lubricants suitable foruse in medical applications on the surface of the guide elements.

The guide elements may comprise one or more set of elements in closeproximity to each other. The guide elements may comprise a set of guideelements that receive the mesh and backing film from the supply spooland facilitate the detachment of the backing film from the mesh. Guideelements may provide for presenting adhesive side of the mesh to thewound site and pressing the mesh down on the wound site for promotingadhesion of the mesh to the patient. In embodiments, the guide elementsare cylindrical in shape, such as, for example, rollers.

At least one guide roller may be positioned at the opening of thehousing, for example, between the ends of the projections from thehousing. A set of guide rollers may be positioned at the opening orbetween the ends of the projections from the housing. The set of guiderollers may be used with one or more rollers within the housing toprovide control of the detached backing film. The set of rollers may bein close proximity to each other, such that the set of rollers assistsin detaching the backing film from the mesh in close proximity to thetissue or wound site. Given the flexible nature of the mesh, it may bedesirable that the length of unsupported mesh (mesh length afterseparation from the backing film), until application to the patient, beminimized. The axial loads required to feed the mesh and backing filmthrough the mesh dispenser may cause the mesh to distort, for example,stretching in length while simultaneously shrinking in width. Forexample, non-optimal conditions may exist when using the mesh dispenserherein disclosed, such as a wet field (blood, saline, or other bodyfluids), or a highly tortuous path-type wound site. The force of themesh trying to recover from a distorted shape to its original shape maycause the mesh to pull loose from the patient, requiring the clinicianto either replace or reposition the mesh. The amount of distortion inthe mesh may increase with unsupported length. By positioning guideelements as close as possible to the point of application to thepatient, unsupported length may be minimized. Small diameter guideelements may be used to provide for an increased release angle betweenthe mesh and backing film, which may minimize the force required toseparate the mesh from backing film.

Preferably, a set of two guide rollers are positioned at the opening,for example, between the ends of the projections from the housing, whichwould provide for one of the set of guide rollers being in contact withthe tissue or wound site during normal operation of the mesh dispensingdevice. In this configuration, one of the set of guide rollers mayindependently assist in the adhesion of the mesh to the wound site,assist in wound approximation, and assist in the forward motion of thedevice along the wound line. In embodiments, the set of guide rollerspositioned between the ends of the projections from the housing are usedin combination with one or more guide rollers positioned within thehousing for controlling the mesh and backing film and detached backingfilm. Other guide elements located within the housing may be used toprevent the mesh from coming in contact with the opening

The mesh dispenser as herein disclosed comprises a spool of mesh andbacking film rotatably loaded on or mounted in the supply spool. Themesh spool is sized to be received by the supply spool or supply spoolsleeve. The mesh with backing film may be wound onto the supply spool.The spool of mesh and backing film may include the sleeve of the abovedescribed slip clutch, the sleeve sized to be rotatably loaded on thesupply spool. Alternatively, the mesh with backing film may be providedon a roller and rotatably loaded on the supply spool. The amount of meshon the spool may be adjusted to minimize the change in diameter of thesupply and take-up spool during use. The supply spool may contain anadequate amount of mesh and backing film as needed for the targetclinical application.

Adequate dead space is provided in the housing to allow backing filmslack to build up due to the fact that the pay-out speed of the supplyspool and take-up speed of the take-up spool decreases ((pay-outspeed)/(take-up speed)_(Time 0)>(pay-out speed)/(take-upspeed)_(Time>0)) as the spools rotate and the mesh is dispensed. Guidingrollers located within the housing are provided to route the detachedbacking film in such a manner as to ensure it does not become tangled inany of the device mechanisms. In embodiments, the take-up spool iscoupled to its drive gear by a clutching mechanism. This mechanism keepsthe liner paper tight so that slack in the device is reduced oreliminated. The device is configured such that the mesh is deployed tothe tissue while pushing or pulling the dispenser forward. In thismanner, the clinician is presented with a clear view of the wound lineon the tissue and is able to provide that the mesh substantially remainscentered about this wound line as it is being applied.

The mesh may be protected within the interior of the mesh dispenseruntil application is started. Means may also be provided to facilitateinitial separation of the mesh from the backing film when applying themesh to the patient. For example, a hand leader (e.g., a strip ofplastic, paper, or other suitable material) may be attached to thebeginning of the mesh at the outer-most wrap of the supply spool. Thehand leader follows the mesh-dispensing path out of the dispenser andmay be attached to the exterior of the housing segments during assemblyand/or prior to use. The starting end of backing film at the outer-mostwrap of the supply spool (corresponding with the hand leader) may bethreaded through the guide elements of the device and may be attached tothe take-up spool.

In use, the outer end of the hand leader is freed from the housing andpulled towards the rear of mesh dispenser. The hand leader initiatesdetachment of the mesh from the backing film and routes the detachedmesh to the opening with the adhesive side of the mesh presented totissue or wound site. The mesh dispenser herein disclosed is positionedat a wound site, for example, near the end or edge of the wound. Aportion of mesh initially presented from the dispenser is adhered to thewound site via a PSA on the mesh starting at a region of the wound lineproximal to the dispenser, and the mesh dispenser is then pushed orpulled along the wound line towards a distal region of the wound line sothe mesh portion initially passes under and later behind the dispenseras the dispenser is moved from the proximal region of the wound line tothe distal region of the wound line. Mesh and backing film are routedpast guide rollers that may provide a separation point for the mesh andbacking film in cooperation with the mesh adhering to the wound site,directing the mesh out of the device to the wound site as well asdirecting the backing film to the take-up spool where it is collected.

A method for dispensing a mesh for tissue bonding using the deviceherein disclosed is also provided. The method is particularly useful fordispensing a spool of mesh comprising a pressure sensitive adhesiveapplied over at least a portion of a bottom side of the mesh, apolymerization initiator disposed in or on the mesh, and a backing filmdetachably adhered to the pressure sensitive adhesive. In embodiments,the method comprises providing a dispensing device with a set of guideelements positioned at the opening of the housing, as herein disclosed.A tissue surface is contacted with the device, where at least a portionof the bottom side of mesh is positioned between the surface and atleast one of the set of guide rollers of the device. At least a portionof the bottom side of the mesh is adhered with the tissue surface. Thedevice is pushed or pulled in a forward direction along the tissuesurface such that the adhered mesh provides rotation of the supply spoolwith separation of the backing film at the set of guide rollers toprovide for dispensing the mesh from the dispensing device.

A method for tissue bonding using the device herein disclosed is alsoprovided. The method comprises providing a tissue surface in need ofbonding. The dispensing device is brought into contact with the tissuesurface, where at least a portion of the bottom side of the mesh ispositioned between the tissue surface and at least one of the set ofguide elements of the device. At least a portion of the bottom side ofthe mesh is adhered with the tissue surface. The mesh is dispensed fromthe opening of the dispensing device by pushing or pulling thedispensing device in a forward direction along the tissue surface. Inthis manner, tissue edge approximation may be performed concurrent withcontrolled placement of the mesh.

The method may further comprise applying a polymerizable adhesivecomposition over and substantially covering at least a portion of themesh; and allowing the polymerizable adhesive composition to permeateinto and under the mesh and polymerize to form a composite structurebonded to the tissue surface.

The adhesive backed mesh used in the dispensing device herein disclosedmay be porous. By “porous” is meant herein either that the bulk of themesh has pores, such that the subsequently applied polymerizableadhesive composition is soaked up or absorbed by the bulk material, orthat the bulk of the mesh has voids (like a net or screen), such thatthe subsequently applied polymerizable adhesive composition passesdirectly through the bulk material, with or without being soaked up orabsorbed by the bulk material. For example, in the case of textilematerials, “porous” is generally used to mean that the applied adhesivecomposition permeates and passes through interstices between the fibers,but does not necessarily pass into and through the fibers themselves.

Such porosity (or other properties such as hydrophobicity orhydrophilicity) will also allow a polymerization initiator or ratemodifier to be loaded in or on the mesh prior to use, to initiate thesubsequently applied polymerizable adhesive composition. Such porositywill also preferably allow air and fluid to pass through the mesh,either through pores per se, or through voids in the bulk material.Depending upon the degree of porosity and/or the size of the openings,such porosity of the mesh or ability of air and fluid to permeatethrough the mesh may be tailored either to remain after a finalcomposite material is formed, or to be absent therefrom. The mesh isalso preferably non-toxic, as it is intended to be used cover a wound,such as on biological tissues. As such, the mesh should be biologicallycompatible with the desired substrate (such as tissue, skin, organ, orthe like), and is preferably a material that is governmentally approvedor generally regarded as safe for the desired purpose. By way ofexample, suitable mesh materials are disclosed in United States PatentApplications 2006/0009099 and 2005/0182443, incorporated herein byreference in their entirety.

The mesh may be a textile or mesh/web material. Suitable textilematerials may be formed of either synthetic or natural materials. Suchtextile material may be formed of either woven or non-woven fabrics ormaterials. The mesh may be, for example, any suitable polymeric film,plastic foam (including open celled foam), a woven fabric, knittedfabric, a non-woven fabric, mixture thereof, or the like. In particular,suitable mesh may thus be prepared, for example, from nylon, apolyolefin film, such as polyethylene, polypropylene, ethylene propylenecopolymers, and ethylene butylene copolymers, polyurethanes,polyurethane foams, polystyrenes, plasticized polyvinylchlorides,polyesters, polyamides, polylactic acid, polyglycolic acid,polycaprolactone, copolymer mixtures of the above, and cotton. Suitablespecific examples include, for example, nylon, polyethylene,polypropylene, ethylene propylene copolymers, ethylene butylenecopolymers, polyurethane, polystyrene, plasticized polyvinylchloride,polyester, polyamide, cotton, polytetrafluoroethylene (PTFE),biovascular material, collagen, Gore-Tex®, DACRON®, etc.

The mesh may be formed of a synthetic, semi-synthetic, or naturalorganic material. Thus, for example, the mesh may be formed of asynthetic or natural polymer material, but not from a material such asmetal (such as silver, steel or the like) or glass or ceramic. The meshmay be either biodegradable, or not biodegradable. The mesh ispreferably resistant to tearing. The thickness of the mesh may be fromabout 0.1 mil to about 80 mils. In another embodiment, the thickness ofthe mesh is from about 0.5 mil to about 20 mils, preferably from about0.7 mil to about 10 mils, or from about 1 mil to about 5 mils.

The mesh may be a strip from about 10 cm to about 80 cm, preferably fromabout 30 cm to about 60 cm in length. The mesh strip may be from about0.1 cm to about 5 cm, preferably from about 1 cm to about 3 cm, morepreferably 2 cm, in width.

The mesh may be selected to be elastic or have some memory effect. Insuch embodiments, the elastic properties of the mesh may desirablyprovide a degree of pressure or stress at the application site, forexample, to maintain wound edge approximation. Likewise, in embodimentswhere such additional degree of pressure or stress at the applicationsite is not desired, the mesh may be selected to have less or noelasticity.

The mesh may be either biodegradable, or not biodegradable. By“biodegradable” is meant that the mesh biodegrades over time in vivo,such that it does not require physical removal of the mesh after a setperiod of time. Thus, for example, a biodegradable mesh is one that, inthe in vivo environment, will biodegrade over a period of from about oneweek to about five years. A non biodegradable material is one that doesnot biodegrade in an in vivo environment within about five years. Such anon biodegradable material thus would require physical removal of themesh at a desired time, rather than slowly deteriorating over time.

The mesh of the mesh dispenser herein disclosed may contain materialssuch as a polymerization initiator, accelerator, rate-modifier, and/orcross-linking agent for initiating polymerization and/or cross-linkingof a polymerizable monomer material. The mesh preferably includes one ormore chemical materials located in or on the mesh. For example, one ormore chemical substances may be dispersed in or on the mesh, such asbeing chemically bound, physically bound, absorbed, or adsorbed to themesh. Thus, for example, the mesh preferably includes at least apolymerization initiator or rate modifier, and may optionally includeone or more bioactive materials. As desired, the one or more chemicalsubstances may be either immobilized in or on the mesh, for example, sothat it has a desired effect but is not detached from the mesh duringuse.

For example, a polymerization initiator or rate modifier may be loadedin or on the mesh so that the initiator or rate modifier provides thedesired initiation or rate modification effect to a subsequently appliedpolymerizable adhesive composition. The polymerization initiator or ratemodifier may be immobilized in or on the mesh, so that the initiator orrate modifier does not become detached from the mesh and its residuesdispersed in the resultant polymeric material. Alternatively, forexample, the polymerization initiator or rate modifier may be initiallyattached to the mesh, but only in such a manner that it becomesmobilized or solubilized by a subsequently applied polymerizableadhesive composition and dispersed in the resultant polymeric material.

If desired, a combination of chemical substances may also be provided inor on the mesh, to provide multiple effects. For example, as describedabove, a first chemical species (such as a polymerization initiator orrate modifier) may be immobilized in or on the mesh, while a second,different chemical species (such as a bioactive material) may bedetachably attached to the mesh. Other combinations of chemical speciesand resultant effects are also envisioned.

When present in or on the mesh, the chemical substances (i.e.,polymerization initiator, rate modifier, and/or bioactive materials, orother additives), may be incorporated in or on the mesh in any suitablemanner. For example, the chemical substance may be added to the mesh bycontacting the mesh with a solution, mixture, or the like including thechemical substances. The chemical substance may be added to the mesh,for example, by dipping, spraying, roll coating, gravure coating,brushing, vapor deposition, or the like. Alternatively, the chemicalsubstance may be incorporated into or onto the mesh during manufactureof the mesh, such as during molding, knitting/weaving, scouring,tenting, plaiting or other processing or the like of the mesh.

The chemical substance may be present in or on the mesh in any suitableconcentration and manner. For example, the chemical substance may beapplied in a uniform manner to the mesh, such that there is asubstantially uniform concentration of the chemical substance across themesh. Alternatively, the chemical substance may be applied such that aconcentration gradient exists across or through the mesh. For example, agreater or smaller concentration of the chemical substance could existat the center or edges of the mesh, or a greater or smallerconcentration of the chemical substance could be applied on one side ofthe mesh as compared to an opposite side. Further, the chemicalsubstance may be applied in a uniform manner to the mesh, or it may beapplied in a non-uniform random or patterned manner (such as lines,dots, concentric circles, or the like). The chemical substances may alsobe on, beneath, or in the pressure sensitive adhesive layer applied tothe mesh.

Other chemical substances that may be present in or on the mesh include,but are not limited to, any suitable and preferably compatible additivethat enhances performance of the composite structure. Such additionalchemical substances may be bioactive or non-bioactive. Suitable otherchemical substances thus include, but are not limited to, colorants(such as inks, dyes and pigments), scents, protective coatings that donot chemically detach, temperature sensitive agents, drugs,wound-healing agents, anti-microbial agents and the like.

The polymerization initiator or rate modifier loaded in or on the meshmay provide a number of advantages for example, the tailoring of thesetting or polymerization time of the applied polymerizable adhesivecomposition. For example, the type and/or concentration of initiatorthat is applied to the mesh may be selected so as to provide faster orslower polymerization time. The concentration of polymerizationinitiator or rate modifier may be increased to provide a fasterpolymerization time, or may be decreased to provide a slowerpolymerization time.

Because the polymerization initiator or rate modifier is loaded directlyin or on the mesh, it is not necessary to mix the polymerizable adhesivecomposition with a polymerization initiator or rate modifier prior toapplication. This may allow a longer working time, where thepolymerizable monomer composition may be more precisely and carefullyapplied over a longer period of time.

Such suitable initiators are known in the art and are described, forexample, in U.S. Pat. Nos. 5,928,611 and 6,620,846, both incorporatedherein by reference in their entireties, and U.S. Patent Application No.2002/0037310, also incorporated herein by reference in its entirety.Quaternary ammonium chloride and bromide salts useful as polymerizationinitiators are particularly suitable. By way of example, quaternaryammonium salts such as domiphen bromide, butyrylcholine chloride,benzalkonium bromide, acetyl choline chloride, among others, may beused.

Benzalkonium or benzyltrialkyl ammonium halides such as benzyltrialkylammonium chloride may be used. When used, the benzalkonium halide may bebenzalkonium halide in its unpurified state, which comprises a mixtureof varying chain-length compounds, or it can be any suitable purifiedcompound including those having a chain length of from about 12 to about18 carbon atoms, including but not limited to C12, C13, C14, C15, C16,C17, and C18 compounds. By way of example, the initiator may be aquaternary ammonium chloride salt such as benzyltrialkyl ammoniumchloride (BTAC).

Other initiators or accelerators may also be selected by one of ordinaryskill in the art without undue experimentation. Such suitable initiatorsor accelerators may include, but are not limited to, detergentcompositions; surfactants: e.g., nonionic surfactants such aspolysorbate 20 (e.g., Tween 20™ from ICI Americas), polysorbate 80(e.g., Tween 80™ from ICI Americas) and poloxamers, cationic surfactantssuch as tetrabutylammonium bromide, anionic surfactants such as sodiumtetradecyl sulfate, and amphoteric or zwitterionic surfactants such asdodecyldimethyl(3-sulfopropyl)ammonium hydroxide, inner salt; amines,imines and amides, such as imidazole, arginine and povidine; phosphines,phosphites and phosphonium salts, such as triphenylphosphine andtriethyl phosphite; alcohols such as ethylene glycol, methyl gallate;tannins; inorganic bases and salts, such as sodium bisulfite, calciumsulfate and sodium silicate; sulfur compounds such as thiourea andpolysulfides; polymeric cyclic ethers such as monensin, nonactin, crownethers, calixarenes and polymeric-epoxides; cyclic and acycliccarbonates, such as diethyl carbonate; phase transfer catalysts such asAliquat 336; organometallics such as cobalt naphthenate and manganeseacetylacetonate; and radical initiators or accelerators and radicals,such as di-t-butyl peroxide and azobisisobutyronitrile.

Mixtures of two or more, such as three, four, or more, initiators oraccelerators may be used. A combination of multiple initiators oraccelerators may be beneficial, for example, to tailor the initiator ofthe polymerizable monomer species. For example, where a blend ofmonomers is used, a blend of initiators may provide superior results toa single initiator. For example, the blend of initiators can provide oneinitiator that preferentially initiates one monomer, and a secondinitiator that preferentially initiates the other monomer, or canprovide initiation rates to help ensure that both monomer species areinitiated at equivalent, or desired non-equivalent, rates. In thismanner, a blend of initiators can help minimize the amount of initiatornecessary. Furthermore, a blend of initiators may enhance thepolymerization reaction kinetics. The polymerization initiator,accelerator, rate-modifier, and/or cross-linking agent may beincorporated into the mesh using impregnation methods known in the art.

The adhesive substance used in the mesh may, for example, be anysuitable adhesive substance. Preferably, the adhesive substance is amedical grade adhesive, such as acrylic based pressure sensitiveadhesives (PSAs), rubber based pressure sensitive adhesives, siliconepressure sensitive adhesives, mixtures thereof, or the like. It ispreferred that the adhesive substance be different from thepolymerizable adhesive composition. Thus, for example, it is preferredthat while the polymerizable adhesive composition can be, for example, apolymerizable monomeric adhesive composition, the adhesive substance isa material that is not a polymerizable adhesive composition, such as apressure sensitive adhesive.

Suitable rubber based PSAs include, but are not limited to, those taughtin U.S. Pat. No. 5,705,551 and in U.S. Pat. No. 4,080,348, thedisclosures of which are hereby incorporated by reference. Examples ofpolymeric rubber bases include one or more of styrene-isoprene-styrenepolymers, styrene-olefin-styrene polymers includingstyrene-ethylene/propylene-styrene polymers, polyisobutylene,styrene-butadiene-styrene polymers, polyisoprene, polybutadiene, naturalrubber, silicone rubber, acrylonitrile rubber, nitrile rubber,polyurethane rubber, polyisobutylene rubber, butyl rubber, halobutylrubber including bromobutyl rubber, butadiene-acrylonitrile rubber,polychloroprene, and styrene-butadiene rubber.

A particularly useful rubber based adhesive is that which has athermoplastic elastomeric component and a resin component. Thethermoplastic elastomeric component contains about 55-85 parts of asimple A-B block copolymer wherein the A-blocks are derived from styrenehomologs and the B-blocks are derived from isoprene, and about 15-45parts of a linear or radical A-B-A block copolymer wherein the A-blocksare derived from styrene or styrene homologs and the B-blocks arederived from conjugated dienes or lower alkenes, the A-blocks in the A-Bblock copolymer constituting about 10-18 percent by weight of the A-Bcopolymer and the total A-B and A-B-A copolymers containing about 20percent or less styrene. The resin component consists of essentially oftackifier resins for the elastomeric component. In general anycompatible conventional tackifier resin or mixture of such resins may beused. These include hydrocarbon resins, rosin and rosin derivatives,polyterpenes and other tackifiers. The adhesive substance may containabout 20-300 parts of the resin component per one hundred parts byweight of the thermoplastic elastomeric component. One such rubber basedadhesive substance is commercially available from Ato Findley under thetrade name HM3210.

Useful acrylic based PSAs include, but are not limited to, those taughtin U.S. Pat. No. 5,947,917 and U.S. Pat. No. 5,164,444 (acrylicemulsion), U.S. Pat. No. 5,623,011 (tackified acrylic emulsion). It canalso be radiation curable mixture of monomers with initiators and otheringredients such as those taught in U.S. Pat. No. 5,686,504 (UV curedacrylic) and U.S. Pat. No. 5,232,958 (EB cured). The disclosures ofthese patents are hereby incorporated by reference.

It is contemplated that any acrylic based polymer capable of forming anadhesive layer with sufficient tack to adhere to the mesh, the backingfilm or to a substrate, and with acceptable adhesion to skin, may beused. In certain embodiments, the acrylic polymers for thepressure-sensitive adhesive layers include those formed frompolymerization of at least one alkyl acrylate monomer or methacrylate,an unsaturated carboxylic acid and optionally a vinyl lactam. Examplesof suitable alkyl acrylate or methacrylate esters include, but are notlimited to, butyl acrylate, ethyl acrylate, 2-ethylhexyl acrylate,isooctyl acrylate, isononyl acrylate, isodecyl acrylate, methylacrylate, methylbutyl acrylate, 4-methyl-2-pentyl acrylate, sec-butylacrylate, ethyl methacrylate, isodecyl methacrylate, methylmethacrylate, and the like, and mixtures thereof. Examples of suitableethylenically unsaturated carboxylic acids include, but are not limitedto, acrylic acid, methacrylic acid, fumaric acid, itaconic acid, and thelike, and mixtures thereof. A preferred ethylenically unsaturatedcarboxylic acid monomer is acrylic acid. Examples of suitable vinyllactams include, but are not limited to, N-vinyl caprolactam,1-vinyl-2-piperidone, 1-vinyl-5-methyl-2-pyrrolidone-, vinylpyrrolidone, and the like, and mixtures thereof.

Useful silicone pressure sensitive adhesives include those commerciallyavailable from Dow Corning Corp., Medical Products and those availablefrom General Electric. Examples of silicone adhesives available from DowCorning include those sold under the trademarks BIO-PSA X7-3027, BIO-PSAX7-4919, BIO-PSA X7-2685, BIO-PSA X7-3122 and BIO-PSA X7-4502.Additional examples of silicone pressure sensitive adhesives aredescribed in U.S. Pat. Nos. 4,591,622, 4,584,355, 4,585,836 and4,655,767, the entire disclosures of which are incorporated herein byreference.

The adhesive substance may also include one or more tackifiers,plasticizers, antioxidants, cutting agents such as waxes, andsurfactants. Other optional materials that may be added to the adhesivesubstance layer in minor amounts (typically less than about 25% byweight of the elastomeric phase) include pH controllers, medicaments,bactericides, growth factors, wound healing components such as collagen,antioxidants, deodorants, perfumes, antimicrobials and fungicides.

The backing film may be any suitable backing or release material used tocover the adhesive substances applied to the bottom side of the mesh.Such backing materials are well known in the art for covering pressuresensitive adhesives and can include, for example, paper, plastic, or thelike. By way of example, the backing film may be a silicone treatedmaterial. Preferably, the backing film is of a material that prevents oreliminates the mesh from sticking to itself when it is wrapped aroundthe supply spool. The backing film may substantially isolate most of theinitiating chemical of the mesh from the PSA (on the bottom surface ofthe mesh) on adjoining layers of mesh and backing film when on thespool.

The method of tissue bonding herein disclosed includes a polymerizableadhesive composition applied over the mesh after the mesh is applied toa tissue or wound site. The polymerizable adhesive composition maycomprise a polymerizable monomeric adhesive. In embodiments, thepolymerizable adhesive composition comprises a polymerizable1,1-disubstituted ethylene monomer formulation. In embodiments, thepolymerizable adhesive composition comprises a cyanoacrylateformulation. In embodiments, synthetic polymerizable adhesive materialssuch as polyurethane, polyethylene glycol, acrylates, glutaraldehyde andbiologically based adhesives may be used.

Suitable α-cyanoacrylate monomers which may be used, alone or incombination, include alkyl α-cyanoacrylates such as 2-octylcyanoacrylate; dodecyl cyanoacrylate; 2-ethylhexyl cyanoacrylate; butylcyanoacrylate such as n-butyl cyanoacrylate; ethyl cyanoacrylate; methylcyanoacrylate or other α-cyanoacrylate monomers such as methoxyethylcyanoacrylate; 2-ethoxyethyl cyanoacrylate; 3-methoxybutylcyanoacrylate; 2-butoxyethyl cyanoacrylate; 2-isopropoxyethylcyanoacrylate; and 1-methoxy-2-propyl cyanoacrylate. In embodiments, themonomers are ethyl, n-butyl, or 2-octyl α-cyanoacrylate. Othercyanoacrylate monomers which may be used include alkyl estercyanoacrylates, such as those prepared by the Knoevenagel reaction of analkyl cyanoacetate, or an alkyl ester cyanoacetate, withparaformaldehyde, subsequent thermal cracking of the resultant oligomerand distillation.

The mesh dispenser herein disclosed may be provided in a kit comprisingadditional components. The kit may comprise at least one mesh dispenserdevice as herein described, and one or more containers of polymerizableadhesive composition.

The different components or groups of components may be sterilized inseparate containers before packaging the components or groups ofcomponents within a kit, and thereafter sterilizing the kit as disclosedin co-assigned U.S. Pregrant Patent Publication No. 2004/0120849,incorporated herein by reference in its entirety. The kit may includeone or more polymerizable adhesive compositions.

Referring now to the Figures, FIGS. 1A and 1B are a perspective views ofembodiments of the mesh dispenser land 1 a, respectively, comprised ofhousing segments 2 and 3, projections 9 (and 9 a), and opening 12 (and12 a). Guide elements 6 and 7 in FIG. 1A are shown guiding detachedbacking film 11 and mesh 10 a at opening 12. FIG. 1B shows dispenser lahaving guide element 7 between projections 9 a at opening 12 a. Optionalgripping means 27 and 28 may provide for user control. Optional indicia25 may provide for indication of the forward direction. FIGS. 2 and 3are an exploded view of the mesh dispenser 1 showing housing segment 3separated therefrom for purposes of depicting the path of mesh, backingfilm, and mesh and backing film through the device and a plan viewdepicting the same elements, respectively. Thus, supply spool 4,rotatably mounted on supply spool axle 40 b, with mesh and backing film10 loaded thereon is rotatably coupled to take-up spool 13, rotatablymounted on take-up spool axle 40 a. Mesh and backing film 10 is receivedby guide element 5 as it pays out from supply spool 4 and is then routedbetween guide elements 6 and 7 mounted at opening 12 on projections 9.Detached backing film 11 is received by guide element 8 and directed totake-up spool 13. Mesh 10 a is dispensed via opening 12 with mesh bottomsurface 21 having PSA presented to tissue or wound site. As depicted inFIGS. 2-3, the mesh dispenser comprises hand leader 30 attached to thebeginning of the mesh at the outer wrap of supply spool 4 (such that themesh may be protected and/or attached to the backing film within theinterior of the dispenser prior to use). Hand leader follows themesh-dispensing path out of the dispenser (e.g., around guide element 7)and may be attached to the exterior of the housing segments. To startmesh application, the end of hand leader 30 is freed from the housingand pulled towards the rear of mesh dispenser 1. The hand leader pullsmesh 10 a from the backing film 11 and routes mesh 10 a around guideelement 7 to present mesh bottom surface 21 having PSA to tissue orwound site.

FIG. 4 is an exploded view of the mesh dispenser embodiment of FIG. 1A,depicting means for elements of take-up spool assembly 13 a, comprisingtake-up spool 16, take-up spool 16 having take-up spur gears 17 coupledwith supply spur gears 18 of supply spool 4. Take up spool assembly 13 aincludes clutch elements including take-up sleeve 14 and o-ring 15providing interference with take-up spool 16. Mesh and backing film 10are shown as detached backing film 11, mesh bottom surface 21 havingPSA, and mesh top layer 22 when separated.

During use of the mesh dispenser device herein disclosed, the adhesiveside of the mesh is presented to the wound site and the device is pushedor pulled forward, for example, in the direction of indicia 25, alongthe wound line. After separating from backing film 11, mesh 10 a passesover guide element 7 and bottom surface 21 is applied to the patient'sskin. After separation from mesh and backing film 10, detached backingfilm 11 is routed past guide element 8 to take-up spool 13.

The present mesh dispenser may be modified without departing from thespirit and scope of the present mesh dispenser. Other embodiments withinthe scope of the claims herein will be apparent to one skilled in theart from consideration of the specification or practice of the inventionas disclosed herein. It is intended that the specification, togetherwith the examples, be considered to be exemplary only, with the scopeand spirit of the invention being indicated by the claims.

What is claimed is: 1-10. (canceled)
 11. A dispensing device comprising:a housing having an opening and wherein the housing further comprises apair of projections which protrude from the distal end of the housing atthe opening; a supply spool rotatably mounted in the housing, the supplyspool comprising a spool of mesh and backing film, the mesh comprising apressure sensitive adhesive applied over at least a portion of a side ofthe mesh, and a backing film detachably adhered to the pressuresensitive adhesive; first and second spaced guide elements mounted atthe opening, with the first guide element receiving the mesh and backingfilm from the supply spool and presenting the pressure sensitiveadhesive side of the mesh at the opening; the first and second guideelements arranged in close proximity to each other, such that the firstand second guide elements assist in detaching the backing film from themesh in close proximity to a tissue or wound site and wherein the secondguide element is located distal to the first guide element and at theprojections protruding the housing at the opening and wherein each guideelement has two end surfaces and a circumferential surface, the majorityof the circumferential surface of the second guide element is notvisually obstructed by the housing; a take-up spool rotatably mounted inthe housing, the take-up spool rotatably coupled with the supply spoolfor receiving the backing film directly from the first guide element;and means for reducing or eliminating binding or slack of the detachedbacking film.
 12. The device of claim 11, wherein the mesh isimpregnated with a polymerization initiator.
 13. The device of claim 11,wherein the means for reducing or eliminating binding or slack of thedetached backing film provides slippage of the take-up spool at a forceof about 0.4 pounds to about 0.6 pounds.
 14. The device of claim 11,wherein the means for reducing or eliminating bonding or slack of thedetached backing film is a slip clutch comprising a sleeve having asleeve inner diameter; and a frictional member positioned between thesleeve inner diameter and the take-up spool.
 15. The device of claim 12,wherein the means for reducing or eliminating binding or slack of thedetached backing film is a slip clutch comprising a sleeve having asleeve inner diameter; and a frictional member positioned between thesleeve inner diameter and the take-up spool.
 16. A dispensing devicecomprising: a housing having an opening and wherein the housing furthercomprises a pair of projections which protrude from the distal end ofthe housing at the opening; a supply spool rotatably mounted in thehousing, the supply spool comprising a spool of mesh and backing film,the mesh comprising a pressure sensitive adhesive applied over at leasta portion of a side of the mesh, and a backing film detachably adheredto the pressure sensitive adhesive; a guide element mounted at theopening and having 2 end surfaces and a circumferential surface in closeproximity to the tissue, the majority of the circumferential surface ofthe second guide element is not visually obstructed by the housing; anda take-up spool rotatably mounted in the housing, the take-up spoolrotatably coupled with the supply spool for receiving the backing filmthe guide element.
 17. The method of claim 16, wherein the mesh isimpregnated with a polymerization initiator.
 18. The device of claim 16,wherein the means for reducing or eliminating binding or slack of thedetached backing film provides slippage of the take-up spool at a forceof about 0.4 pounds to about 0.6 pounds.
 19. The device of claim 16,wherein the means for reducing or eliminating bonding or slack of thedetached backing film is a slip clutch comprising a sleeve having asleeve inner diameter; and a frictional member positioned between thesleeve inner diameter and the take-up spool.
 20. The device of claim 17,wherein the means for reducing or eliminating binding or slack of thedetached backing film is a slip clutch comprising a sleeve having asleeve inner diameter; and a frictional member positioned between thesleeve inner diameter and the take-up spool.